title: Application of transient elastometry to differentiate mild from moderate to severe liver fibrosis in HIV/HCV co-infected patients.
abstract: OBJECTIVE
  Transient elastometry (TE) is accurate for detecting cirrhosis (F=4) in human immunodeficiency virus (HIV)/hepatitis C virus (HCV) co-infected patients. However, this procedure is less precise to differentiate mild (F < or = 1) from moderate to severe (F > or = 2) fibrosis using the cut-off value of 7.2kPa, a level previously proposed by some authors. Because of this, we elaborated and validated cut-off values of liver stiffness (LS) to better discriminate F < or = 1 from F > or = 2 in HIV/HCV co-infected subjects to aid therapy decisions.
  
  
  METHODS
  One hundred and ninety-seven co-infected patients with liver biopsy and TE measurement, without prior therapy against HCV infection, were included.
  
  
  RESULTS
  To diagnose F < or = 2, a cut-off of 9.0kPa showed a positive predictive value of 87%. To discard F > or = 2, a cut-off of 6.0kPa showed a negative predictive value of 90%. Considering all the patients, 61 (31%) patients yielded LS values < or = 6.0kPa and 81 (41%) patients showed LS values > or = 9.0kPa. There were no severe classification errors as the NPV of L < or = S6.0kPa for F > or = 3 was 100% and the NPV LS > or = 9.0kPa for F=0 was also 100%.
  
  
  CONCLUSIONS
  The usefulness of TE can be enhanced using two different cut-off values to identify patients with F < or = 1 and F > or = 2.
authors.affiliation: Clinical Unit of Infectious Diseases, Department of Internal Medicine, Seville, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Macías
authors.forename: Eva
authors.initials: E
authors.lastname: Recio
authors.forename: Eugenia
authors.initials: E
authors.lastname: Vispo
authors.forename: Antonio
authors.initials: A
authors.lastname: Rivero
authors.forename: Luis F
authors.initials: LF
authors.lastname: López-Cortés
authors.forename: M José
authors.initials: MJ
authors.lastname: Ríos
authors.forename: Dolores
authors.initials: D
authors.lastname: Merino
authors.forename: Mercedes
authors.initials: M
authors.lastname: González
authors.forename: Pablo
authors.initials: P
authors.lastname: Barreiro
authors.forename: Victor
authors.initials: V
authors.lastname: de Lédinghen
authors.forename: Carmen
authors.initials: C
authors.lastname: Quereda
authors.forename: Juan A
authors.initials: JA
authors.lastname: Pineda
mesh_terms: D000368:Aged; D001706:Biopsy; D003938:Diagnostic Techniques, Digestive System / Q000592:standards*; D004548:Elasticity; D005260:Female; D015658:HIV Infections / Q000150:complications*; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000473:pathology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012720:Severity of Illness Index